E0863B
Jurisdiction of City of Slair, Nebraska
29 8 South 16th Street
Slair, Nebraska 68008
(402) 426-4191 Permit. ~ ~ ~~
Application Date: /~
Permit Fee: $ ` "
JOB ADDRESS / 6~
LEGAL
1 • DESCR. LOT ND. BLK, TRACT
®SEE ATTACHED SHEET
2. OWNER '° MAI ADDRESS IP PHONE
^.."
3• CONTRACTOR ¢ MAIL ADDRESS PONE LICENSE NO.
4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL ®REMODELING/ADDITIONS ®UPGRADE SERVICE
5• Describe Work: ~ - t
6• Current License on File es O No ®NA
New Service Fee = (Amp Fee + $2.00 per branch circuit) L CTICAL PERMIT F
1-100 Amp Fee ............................ $ 13.00 Upgrade Existing Service ...... $10.00
101-200 Amp Fee ............................ $ 18.00 Temporary Service ................ $10.00
201-300 Amp Fee ............................ $ 30.00 Fire Alarm System ................. $10.00
301-400 Amp Fee ............................ $ 42.00
Signs .....................................$15.00
401-500 Amp Fee ............................ $ 55.00
501-600 Amp Fee $ 67.00
............................ Miscellaneous Apparatus ...... $11.00
601-700 Amp Fee ............................ $ 80.00 AC/DC Circuit ........................ $5.00
701-800 Amp Fee ............................ $ 92.00
801-900 Amp Fee $105.00 Commercial/Multi-Family and All Upgrades:
901-1000 Amp ................................. $117.00 # of Circuits x $2.00 1 °"
~ ~ ~
IF OVER 1000 Amp
1
t 1000 A
F Amp Fee ,r~ '~,~~~~'j ~'~
~~
s
mp
ee ....................... $117.00 .
Each additional 100 Amps ........,,. $ 13.00 Amp Fee + Circuit Total
N
R
id
ti
l
Fi
i
h
d A
ew
es
en
a
: (
n
s
e
rea)
NOTICE Single/Two Family Dwellings
I hereby certify that I have read and examined this sq. ft. x .045
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of Modular/Manufactured Homes ....... $30.00
work will be co
li
d
ith
h
th
ifi
d h
i
t
mp
e
w
w
e
er spec
e
ere
n or no
.
The granting of a permit does not presume to give authority Receptacle/Switch Outlets
to violate or cancel the provisions of any other state or local Fixtures x $.75
law regulating construction or the performance of Smoke Detectors x $3.00
construction.
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Motor(s) x $3.00
c ,~ Power Apparatus (220 Volts)
SIGNATURE OF CONTRACTOR OR HORIZED AGENT # Apparatus x $3.00
~. ®/ ~ '~ Permit Issuance Fee .............$15.00
DATE
T®TA~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTG: Blair, NE Rev. B/97
~.
T ~_~___ __ r - ____ _--- ----,
;~-' ZJI liT EC T
K£
i~ CIT`Y OF BI:AIIt ^ WASHINGTON COUNTY ^ OTHER '!
LOCATION OF INSPECTION: ~~ '-> ~' ~-° %-~- ~ ~ ~!
J ~~ y `~.: r' ~ '~
NAME OF OWNER: ~'~•'$1 P a?~'lL' f;' ~ ? ~ r';:%~ CONTRACTOR• ~-°-°%~-l~~ ~'_-~-'L.~°""~~ ~
~~ I
-DATE INSPECTION REQUESTED: PERMIT NO: _`~'r%''"~~f~i '%~ ~ ~Y; ~~,:~_'~ i
~,
TIME INSPECTION REQUESTED: ~~ t ~ ~?
~~1
TYPE OF INSPECTION REQUESTED: ,
BUILDING:
^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL '
r.
;;
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ' ..! I
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
i
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING: j
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: ~ASSED ~s~xo~ras> ^ FAILED ~s~xo~s>
NOTES/REMARKS: ///
i
-- ..
. INSPECTOR:: _-~' _-~-;~_-'~ ,.''` ,,r`~...-~e~.--~ ~ ~ ~'
DATE OF INSPECTION MADE•:'-~~~`~~--y~ `~~`' .~ TIME: c ~~ i
~ .- i
~!
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
,. WANT-OFFICE STAFF TO CALL OPPD\ ; ^ YES... ^N0. BLR 1 j
D ~